IOP monitoring and pharmacological hypotensive therapy specifics in primary open-angle glaucoma

Purpose: To study the effectiveness of various hypotensive regimens to determine the optimal tactics for managing patients with POAG.

Material and methods: The study included a total of 314 (628 eyes) patients with newly diagnosed POAG (stages I-III): 97 men (30.9%), and 217 women (69.1%). The average age was 65.8±2.04 years; 64.6±1.52 in male patienrs and 66.3±1.72 years in females. The following parameters were studied: age, anamnesis (concomitant somatic pathology), disease stages, IOP level at baseline and, 1, 3, 6, 12, 18 and 24 months after the start of hypotensive therapy, drug drug regimen and its changes.

Results: Over the entire study period, there was a regimen change from β-blockers monotherapy in 50.0% of mild POAG patients and 48.6% of moderate POAG patients, because they could not achieve “target pressure”. In 5.9% of moderate stage cases and 18.2% of advanced stage cases, disease progression into the next stage was recorded. Monotherapy with prostaglandin analogues (PA) was effective in patients with mild POAG. 24.7% of moderate glaucoma patients showed IOP level corresponding with the upper limit of the recommended range, despite a significant IOP decrease compared to baseline. In these cases the level the patients were prescribed an additional drug from another pharmacological group. PA monotherapy was not effective in patients with advanced glaucoma, leading to the disease progression into the terminal stage in 5 eyes. A combination of PA and β-blockers (BB) helped achieve the recommended IOP level in patients with mild and moderate POAG. The same regimen proved insufficient for patients with advanced glaucoma, leading to a disease progression. A fixed BB+PA combination regimen administration showed the same tendencies with a 20.8% progression rate in advanced glaucoma patients.

Conclusion: It is necessary to prescribe drugs (prostamides, prostaglandin analogues) that could provide a sufficient reduction of the IOP level and contribute to the longterm stabilization of the disease.

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